How to buy a baby daughter

Megan Simpson always expected that she would be a mother to a daughter. She had grown up in a family of four sisters. She liked sewing, baking and doing hair and makeup. She hoped one day to share these interests with a little girl she could dress in pink.

Simpson, a labor and delivery nurse at a hospital north of Toronto, was surprised when her first child, born in 2002, was a boy. That's OK, she thought. The next one will be a girl. Except it wasn't. Two years later, she gave birth to another boy. Desperate for a baby girl, Simpson and her husband drove four hours to a fertility clinic in Michigan. Gender selection is illegal in Canada. They paid $800 for a procedure based on the assumption that sperm carrying a Y chromosome swim faster than sperm with an X chromosome do. Simpson was inseminated with slower sperm that same day. Fifteen weeks later, she asked a colleague at the hospital to sneak in an after-hours ultrasound. The results felt like a brick landing on her stomach: another boy.

"I lay in bed and cried for weeks," said Simpson, now 36, whose name has been changed to protect her privacy. She and her husband talked about getting an abortion, but decided to continue with the pregnancy. In the meantime, she looked for a way to guarantee that her next child would be the daughter she had always dreamed about. She discovered an online community of women just like her, confiding deep-seated feelings of depression over giving birth to boys. The forums mentioned a technique that would guarantee her next baby would be a girl. It would cost tens of thousands of dollars, money Simpson and her husband did not have. Simpson waited until her third sonwas born. Then she began to make some phone calls..

'FAMILY BALANCING'

The conventional wisdom has always been this: Given a choice, couples would prefer sons. That has certainly been the case in China and India, where couples have used pregnancy screening to abort female fetuses. But in the United States, mothers are using expensive reproductive procedures to select girls.

Just over a decade ago, some doctors saw the potential profits that could be made from an untapped market of young, fertile mothers. They trolled online forums, offering counseling. They coined the phrase "family balancing" to make sex selection more palatable. They gave away free DVDs and set up slick websites.

These doctors have turned a procedure originally designed to prevent genetic diseases into a luxury purchase akin to plastic surgery. They foresee an explosion in sex-selection procedures on the horizon, as couples become accustomed to the idea.

LOOKING FOR XX

Inside a fourth-floor office suite off a palm-tree-lined street in Encino, Calif., two men wearing maroon scrubs peer into high-tech microscopes. The men are fertilizing human eggs with sperm samples collected that day.

After fertilization and incubation, an embryologist uses a laser to cut a hole through an embryo's protective membrane and picks out one of the eight cells. Fluorescent dyes allow the embryologist to see the chromosomes and determine whether the embryo is carrying the larger XX pair of chromosomes or the tinier XY.

The lab is part of the Fertility Institutes, a clinic set up by Jeffrey Steinberg, one of the most prominent gender selection doctors in the United States. In his spacious, oak-paneled office down the hall, Steinberg is surrounded by photos of his own naturally conceived children. His clinic is the world leader for this technique, known as preimplantation genetic diagnosis (PGD).

"We're by far number one. Number two is not even a close second," he said.

The United States is one of the few countries that legally allows PGD for sex selection. The procedure was designed in the early 1990s to screen embryos for chromosome-linked diseases. It is illegal for nonmedical uses in Canada, the U.K., and Australia.

Steinberg's gender-selection patients are typically around 30 years old, educated, married, middle to upper class. They typically have a couple of children already.

Steinberg said he never intended to make gender selection his niche. But then the ethics committee of the American Society for Reproductive Medicine, a nonprofit organization, came out against prenatal sex selection for nonmedical reasons in 1994. That made Steinberg angry.

"I took it on as a challenge," he said. "The fact that they didn't like it, and the fact that I saw nothing wrong with it, made me more aggressive."

He advertised in Indian-American and Chinese-American newspapers. He was accused of stoking cultural biases for boys in those communities, and his ads were pulled. In 2009, Steinberg announced on his website that couples could also choose their baby's eye and hair color. He revoked the offer after receiving a letter from the Vatican.

PRINCESS DREAMS

Many women who undergo PGD for gender selection discovered the procedure in online forums. Reading the posts on these forums is like entering another world. Users adorn their avatars with pink and princess imagery. They share notes on PGD, recounting in detail their own experiences.

Competition is stiff for search-friendly domain names for clinic websites. There's genderselection.com, not to be confused with gender-selection.com. There's also gender-select.com and genderselectioncenter.com, all websites maintained by fertility clinics promoting PGD. These sites are filled with glossy stock photos of happy families, polished YouTube videos of doctors making their pitch, and patient testimonials in numerous languages.

In May 2008, Simpson and her husband traveled to California to undergo PGD at the Laguna Hills branch of the Huntington Reproductive Center. There, she met up with women she had made friends with online.

"We went shopping and picked out girly clothes and dreamed of the day we could have a baby to wear them," Simpson recalled.

Three days after arriving in California, Simpson underwent egg retrieval surgery. Eighteen eggs were retrieved; of these, 11 were mature and were fertilized. After resting for five days, Simpson returned to the clinic for her embryo transfer.

She was met with devastating news: all of her embryos were found to be chromosomally abnormal. None were useable.

"I cried. And cried some more," recalled Simpson. "All that money, the drugs, the travel, time off work. The money."

Three months later, she was back in Laguna Hills. She had taken out $15,000 on a line of credit to pay for the second attempt. She went through the whole process again. This time, the embryos were good to go. An ultrasound was used to guide a catheter containing the embryos into her uterus. Six days later, Simpson took a pregnancy test. It was positive.

When she was 15 weeks pregnant, she asked a friend at work to once again sneak her into an after-hours ultrasound. But this time, it was different. After nearly four years and $40,000, Simpson's dreams of being a "girl-mommy" were going to come true.

Simpson gave birth to her daughter during a home delivery in her bathtub in 2009.

"The moment she was born, I asked if it was still a girl," she recalled.

Simpson had to work six days a week right up until the delivery and for months afterward to repay the loan.

"My husband and I stared at our daughter for that first year," she said. "She was worth every cent. Better than a new car, or a kitchen reno."

FEMALE BONDING

Much of the evidence that Americans preferentially choose girls is anecdotal. But data from Google show that "how to have a girl" is searched three times as often in the United States as "how to have a boy." Many fertility doctors say that girls are the goal for 80 percent of gender-selection patients.

So where does this preference come from? For Jennifer Merrill Thompson, the reasons were simple.

"I'm not into sports. I'm not into violent games. I'm not into a lot of things boys represent and boys do," she said.

Interviews with several women from the forums at in-gender.com and genderdreaming.com yielded the same stories: a yearning for female bonding. Relationships with their own mothers that defined what kind of mother they wanted to be to a daughter. A desire to engage in stereotypical female activities they thought would be impossible with a baby boy.

The American Society for Reproductive Medicine says it's concerned that gender selection is leading otherwise healthy women to undergo unnecessary medical procedures. And the group fears that children born through gender selection would be pressured to live up to stereotypes of the gender that was picked out and paid for by their parents.

"It's high-tech eugenics," said Marcy Darnovsky, director of the Center for Genetics and Society, a Berkeley, Calif. nonprofit. "If you're going through the trouble and expense to select a child of a certain sex, you're encouraging gender stereotypes that are damaging to women and girls. ... What if you get a girl who wants to play basketball? You can't send her back."
Jasmeet Sidhu is a writer and filmmaker based in New York City. Reporting for this story was supported by the Stabile Center for Investigative Journalism at Columbia University.

Last modified: September 24, 2012
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